AccountId: 011433970860
ContactId: 6b3a949c-7e02-4b2f-8ed5-6684d48ffeae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220860 ms
Total Talk Time (AGENT): 118612 ms
Total Talk Time (CUSTOMER): 50788 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/6b3a949c-7e02-4b2f-8ed5-6684d48ffeae_20250121T14:50_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm calling from Miami Vascular Surgery. I was calling to check on the benefits of, uh, one of your members.
[AGENT][NEUTRAL] OK, [PII], you're needing to check uh benefits only or do you also need eligibility?
[CUSTOMER][POSITIVE] Um, both, please. I'm sorry.
[AGENT][POSITIVE] Uh, yes, I can help you with that. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Yes, give me 1 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, OK, so it's 02556517 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I did see that he is a subscriber on the supplemental policy. It is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, office.
[AGENT][NEUTRAL] OK, so on this policy, office visits are not covered. However, if there is some form of treatment rendered within the office, he does have a treatment writer on here that we can review benefits for the treatment under his outpatient benefit maximum and that outpatient benefit maximum per calendar year for covered outpatient services per covered person.
[AGENT][NEUTRAL] Is $8700 and there is no outpatient deductible.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And then, uh, lastly I'm sorry you said office visits were not covered with this uh supplemental plan?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK perfect I'll go ahead and mark that here OK perfect thank you so much I really appreciate your help.
[AGENT][NEUTRAL] And then, yes, [PII] and just a couple of additional things when the claim is submitted to APL for review, we will also have to have a copy of the primary insurance company's explanation of benefits as well and then once we have.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Process our claim we do have a portal in which you should be able to check claim status and have access to the explanation of benefits, and our portal website is secured. [PII].
[CUSTOMER][POSITIVE] Perfect. OK, perfect. I'll go ahead and write that information here and thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, well you're certainly welcome. So if that's all then that I could help you with, thank you again for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Same to you bye bye.